{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T16:03:31Z","timestamp":1765382611667,"version":"3.46.0"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n The continuous Medicaid enrollment provision adopted during the COVID-19 pandemic ended in March 2023, after which 24 million US residents were disenrolled. Prior studies suggest this \u201cunwinding\u201d was associated with increased discontinuation of buprenorphine, an effective treatment for opioid use disorder. On December 1, 2023, North Carolina expanded Medicaid to low-income adults under the Patient Protection and Affordable Care Act (ACA).<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate changes in buprenorphine dispensing following North Carolina\u2019s Medicaid expansion.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cross-sectional study used a difference-in-differences analysis of the IQVIA Longitudinal Prescription Database, which captures 92% of US prescriptions. The analysis was limited to North Carolina and South Carolina, which has not expanded Medicaid under the ACA. The sample included adults with Medicaid-paid buprenorphine prescriptions from March to May 2023, 3 months before unwinding began in these states. The preintervention period was June 1 to November 30, 2023, and the postintervention period was December 1, 2023 to December 31, 2024.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n North Carolina\u2019s Medicaid expansion.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Monthly proportion of patients with at least 1 active buprenorphine prescription; monthly proportion of patients with at least 1 active prescription paid by Medicaid, private insurance, or cash. Linear probability models estimated differential changes in outcomes over time in North Carolina vs South Carolina.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Analyses included 286\u202f216 person-months of data from 15\u202f064 patients (mean [SD] age, 39.8 [9.2] years; 210\u202f881 person-months [73.7%] contributed by women). The monthly proportion of patients with at least 1 active buprenorphine prescription declined by 11.3 and 11.2 percentage points in North Carolina and South Carolina, respectively, between June and November 2023. North Carolina\u2019s Medicaid expansion was associated with a 1.6 (95% CI, 0.9-2.3) percentage point differential increase in this proportion, a 7.4 (95% CI, 5.7-9.1) percentage point differential increase in the probability of having at least 1 Medicaid-paid prescription, a \u22124.1 (95% CI, \u22125.2 to \u22123.0) percentage point differential change in the probability of having at least 1 private-pay prescription, and a \u22121.4 (95% CI, \u22122.6 to \u22120.3) percentage point differential change in the probability of having at least 1 cash-pay prescription.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cross-sectional study of prescription dispensing data, North Carolina\u2019s Medicaid expansion was associated with a slowing of the decline in buprenorphine dispensing that occurred after unwinding of Medicaid continuous coverage requirement began. Medicaid expansion may have partially mitigated the adverse changes in buprenorphine dispensing associated with unwinding.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.47933","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T16:00:41Z","timestamp":1765382441000},"page":"e2547933","source":"Crossref","is-referenced-by-count":0,"title":["Buprenorphine Dispensing Following Medicaid Expansion Amid Unwinding in North Carolina"],"prefix":"10.1001","volume":"8","author":[{"given":"Joanne","family":"Constantin","sequence":"first","affiliation":[{"name":"Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor"},{"name":"Department of Health Policy and Management, School of Public Health, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kao-Ping","family":"Chua","sequence":"additional","affiliation":[{"name":"Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor"},{"name":"Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey S.","family":"McCullough","sequence":"additional","affiliation":[{"name":"Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"zoi251288r3","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.jsat.2015.05.001","article-title":"Risk factors for relapse and higher costs among Medicaid members with opioid dependence or abuse: opioid agonists, comorbidities, and treatment history.","volume":"57","author":"Clark","year":"2015","journal-title":"J Subst Abuse 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dispensing.","volume":"8","author":"Constantin","year":"2025","journal-title":"JAMA Netw Open"},{"key":"zoi251288r12","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.jsat.2018.08.012","article-title":"Health insurance coverage is associated with access to substance use treatment among individuals with injection drug use: evidence from a 12-year prospective study.","volume":"96","author":"Feder","year":"2019","journal-title":"J Subst Abuse Treat"},{"key":"zoi251288r15","doi-asserted-by":"publisher","DOI":"10.1016\/j.dadr.2024.100262","article-title":"Simulating the effects of Medicaid expansion on the opioid epidemic in North Carolina.","volume":"12","author":"Berghammer","year":"2024","journal-title":"Drug Alcohol Depend Rep"},{"key":"zoi251288r20","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2022.103715","article-title":"A mixed methods study of provider factors in buprenorphine treatment 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Understanding the opioid overdose epidemic. Updated November 1, 2024. Accessed December 8, 2024, https:\/\/www.cdc.gov\/overdose-prevention\/about\/understanding-the-opioid-overdose-epidemic.html"},{"key":"zoi251288r2","unstructured":"AcademyHealth: Evidence-Informed State Health Policy Institute. Medicaid & care for opioid use disorder: what\u2019s the evidence? Accessed December 8, 2024. https:\/\/academyhealth.org\/sites\/default\/files\/medicaid_oud_disorder_care_final.pdf"},{"key":"zoi251288r10","unstructured":"Tolbert J, Moreno S, Rudowitz R. 10 Things to know about the unwinding of the Medicaid continuous enrollment provision. Kaiser Family Foundation. Updated May 9, 2023. Accessed January 5, 2025. https:\/\/www.kff.org\/medicaid\/state-policy-choices-are-likely-to-affect-the-extent-of-medicaid-enrollment-declines-during-the-unwinding-period\/"},{"key":"zoi251288r13","unstructured":"North Carolina Medicaid. North Carolina expanded health care coverage to more people. 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Accessed November 4, 2025. https:\/\/www.bostonfed.org\/publications\/current-policy-perspectives\/2021\/the-medicaid-expansion-and-the-uptake-of-medication-assisted-treatment-for-opioid-use-disorder.aspx","DOI":"10.2139\/ssrn.3832241"},{"key":"zoi251288r24","doi-asserted-by":"crossref","unstructured":"Datta? A, Oglesby? W, George? B. Access to health insurance and treatment utilization for opioid use disorder: evidence from state Medicaid expansions. Research Square. Preprint posted online January 12, 2022. doi:10.21203\/rs.3.rs-1220775\/v1","DOI":"10.21203\/rs.3.rs-1220775\/v1"},{"key":"zoi251288r30","unstructured":"Foundation for Opioid Response Efforts. Is treatment for opioid use disorder affordable for those with public or private health coverage? November 2021. Accessed April 11, 2025. https:\/\/forefdn.org\/wp-content\/uploads\/2021\/11\/fore-moud-insured.pdf"},{"key":"zoi251288r31","unstructured":"TechTarget. 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